Healthcare Provider Details

I. General information

NPI: 1174740807
Provider Name (Legal Business Name): PAULA BERRY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HICKORY RD STE 240
PLYMOUTH MEETING PA
19462-2225
US

IV. Provider business mailing address

10412 MAYAPPLE CT
NOBLESVILLE IN
46060-6760
US

V. Phone/Fax

Practice location:
  • Phone: 610-834-1122
  • Fax: 610-834-7525
Mailing address:
  • Phone: 317-776-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32000130
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: